A comparison of spontaneous labor with induced vaginal tablets prostaglandin E2 in grand multiparae

OBJECTIVE: To compare the outcome of labor in grandmultiparous patients (para >5) who had induction of labor with prostaglandin E2 vaginal tablets with grandmultiparous patients in spontaneous labor, and to observe the complications during induction of labor.

METHODS: A retrospective case control study was carried out at King Faisal Military Hospital, Khamis Mushayt between January 1993 through until December 1994. This included 64 grandmultiparous patients that were induced with prostaglandin E2 vaginal tablets. Ninety grandmultiparous patients who went into labor spontaneously served as controls. Maternal and fetal data extracted from their hospital record files included age, parity, indication for induction, Bishop score at induction, total dose of prostaglandin used and complications of induction of labor. Other information were length of labor, need for syntocinon augmentation, blood loss during the 3rd stage of labor, mode of delivery, birth weight, sex and Apgar score at 10 minutes.

RESULTS: No serious complication of induction of labor such as rupture of the uterus was noted in the subjects studied. There were no significant differences when the mean age and parity of patients in the 2 groups were compared (P>0.05) but there was difference in the gestational age at delivery (p=0.00). There was no significant difference in the mean length of first and 2nd stages of labor. The cesarean section rate was 11% and 8% in the cases and controls, while the need for syntocinon augmentation was twice in the cases than controls, 27% vs 14%. These were not statistically significant.

CONCLUSION: We conclude that induction of labor with prostaglandin E2 vaginal tablets may not have adverse effect on the outcome of labor compared with patients in spontaneous labor. It may be safe to use prostaglandin E2 vaginal tablets for induction of labor in the grand- multiparae. We recommend a randomized prospective trial to validate these observations.